Abuse and Suicide

1
Abuse and Suicide

• Rosalie C. Diaz, Psy.D. UTMB-SAHS 2006

2
Spouse Abuse

• Statistics
• 2-12 million families in the US
• Long standing-severe problem
• 1.8 million battered wives
• Substance Abuse, esp Al CC
• Abusive men come from violent homes
• Abusers are immature, dependent,
  non- assertive, feelings of inadequacy

3
Course of Development

• Aggression and bullying behavior is designed to
  humiliate spouse and build upon their low
  self-esteem
• Displaced aggression
• 50 of battered wives grew up in violent homes
• Isolates spouse
• When they leave, 75 have a greater chance of
  being killed than the ones that stay
• Some men feel remorse and guilt (cry, give gifts,
  ask for forgiveness).

4
The Cycle of Violence
5
Tension-Building Period

• THE ABUSER MAY
• be moody, sullen, faultfinding and verycritical.
• withdraw affection
• isolate partner
• belittle partner
• drink and/or take drugs
• make threats
• destroy partner's personal property
• engage in inconsistent and "crazy-making"
  behavior

• THE VICTIM MAY
• attempt to keep partner calm and placate partner
• become overly accommodating, agreeable,
  solicitous and nurturing
• become silent, or overly- talkative
• withdraw from, and avoid, family and friends
• try to keep the kids quiet and "out of the way"
• constantly feel as if she is "walking on eggshell
  

6
Violent or Abusive Incident

• THE ABUSER MAY
• beat partner, often severely
• rape partner
• attack partner with weapon
• isolate partner from family and friends
• imprison partner
• become extremely verbally abusive
• humiliate and degrade partner, often publicly

• THE VICTIM MAY
• protect herself any way she can
• attempt to calm abuser down
• try to reason with abuser
• call the police
• fight back
• leave, or attempt to leave

7
Respite Period

• THE ABUSER MAY
• apologize, cry, and beg for forgiveness
• make declarations of love and want
• promise to get help, to go for counseling to AA,
  to do "whatever it takes"
• send flowers and presents
• take partner out lavishly
• enlist support from family, friends, clergy and
  the children
• promise it will never happen again

• THE VICTIM MAY
• agree to stay, return, or take abuser back
• cancel, or try to cancel, legal proceedings
• make appointments with counselor or therapist for
  abuser and self
• cancel those appointments because things seem to
  be better
• feel happy and hopeful
• believe it will never happen again

8
Warning Signs

• Extreme jealousy
• Constant put-downs
• Telling the other person what to do
• Explosive temper
• Possessiveness
• Big mood swings
• Making false accusations
• History of violence
• Isolating the other person from family and
  friends
• Financial control

9
Pregnancy

• High risk time for battering
• 15-25 of pregnant women are physically abused
  while pregnant and abuse often results in birth
  defects

10
Rape

• 93,433 forcible rapes in 2003
• Highly under reported, estimated 4-5 out of 10
  are reported
• In 2003 63.2 of every 100,000 women in the US
  were forcibly raped
• Women between the ages of 15 and 21 are at higher
  risk. The average age is 18
• 80 of all sexual assaults are committed by an
  acquaintance of the victim

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Definition of Rape

• Conventional perpetration of an act of sexual
  intercourse with a woman against her will and
  consent
• Whether by force, coercion, threat of force,
  drugs/intoxicants, or due to mental deficiency is
  unable to exercise reasonable judgment or below
  the age of consent
• Forced acts of fellatio and anal penetration,
  though frequently accompany rape are considered
  sodomy

12
Course of Development of Rape

• The rape event is frequently a life threatening
  situation
• Humiliation is often used as part o the rape act
• Effects may last a year or longer (PTSD)
• Usually depend on the level of violence of the
  attack
• Therapy can restore the survivors sense of self
  esteem, adequacy, and control over her life

13
Child Abuse

• Statistics
• 3 million cases reported, 1 million confirmed in
  1994
• In the US Child Abuse results in 2000-4000 deaths
  annually, 150,000-200,000 sexual abuse acts
  yearly against children
• 1/3-4 girls, 1/7-8 boys will be sexually
  assaulted before they are 18
• Many go unrecognized and untreated
• 32 less than 5 yo 27 5-9 yo 2710-14 yo 14
  15-18 yo
• Most child abuse is from parents (75), relatives
  (15) or unrelated caretakers (15)

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Etiology

• Abusive parents have often been abused
• Stressful living conditions
• Parents have mental disorder
• Children are premature, disabled, MR, physically
  disabled, cry excessively
• Abusive parents have unrealistic expectations
• Perp is more often mother than father
• Men are perps in 95 of cases of sexual abuse of
  girls and 15 sexual abuse of boys

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Indicators of Child Abuse and Neglect

• Child-related signs of possible abuse or neglect
• Suspicious burns, bruises, injuries
• Often tired, hungry, or not clean
• Needs glasses or dental/medical care
• Extreme aggression and/or passivity
• Lags in development
• Afraid of parents or adults
• Mood swings
• Avoids physical contact
• Reports being hurt or abused
• Unusual sexual awareness or behavior

• Parent or caregiver signs of possible abuse
• Misuses alcohol or other drugs
• Disorganized, upset home life
• Does not seem to care what happens
• Isolated, doesn't seem to get along with others
• Uses inappropriate, harsh discipline
• Sees child as very bad or evil
• Gives questionable explanation of childs injury

16
Physical Indicators

• Suspicious bruises, marks that form symmetrical
  patterns
• Burns by cigarettes leave round marks and perfect
  lines are usually intentional scalding
• Retinal hemmorage in infants may be due to shaking

17
Emotional and/or Psychological Abuse

• Depression or apathy
• Child is withdrawn
• Demonstrates acting out or behavioral problems
• Overly concerned with detail
• Child demonstrated exaggerated fears or
  antisocial behaviors
• Constantly seeks out attention and affection from
  adults

18
Child Neglect

• Lack of adequate medical or dental care
• Child is always dirty or inadequately dressed
• Poor supervision/left home alone
• Inadequate nutrition
• Unsanitary environmental conditions

19
Child Sexual Abuse

• Enuresis of fecal soiling
• Eating disturbances
• Fears, phobias, compulsive behaviors
• Age-inappropriate behavior
• Problems with school performance, attitudes,
  difficulty concentrating
• Substance abuse
• Self-destructive behavior
• Fire setting
• Sudden possession of money, new clothes or toys
• Physical trauma or irritation to the anal or
  genital area

20
Suicide

• Suicide is the eighth leading cause of death in
  the United States. More years of life are lost to
  suicide than to any other single cause except
  heart disease and cancer
• 30,000 Americans commit suicide annually an
  additional 500,000 Americans attempt suicide
  annually
• 30 to 40 of persons who commit suicide have
  made a previous attempt
• 75 suicides per day, 1 every 20 minutes
• Prime suicide site is the GGB, 800 since it
  opened in 1937

21
Prediction

• Goes up with age
• 10 of total pop older adults account for 25
  and those 75 and older have 3x that of young
  adults
• Alcohol
• 15 are alcohol related
• 7000-13000 alcohol dep persons per year commit
  suicide
• 80 are male

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Prediction Continued

• Impulsive and Angry
• 40 of depressed patients who commit suicide have
  made a previous attempt
• Men are 3x likely to use suicide as women
• Women are 4x more likely to attempt
• Men are more successful because of their methods
• Suicide rate for males 15-24 is still rapidly
  rising
• For men 25-34 rate increased almost 30 over the
  past decade

23
Warning Signs

• Verbal suicide threats such as, Youd be better
  off without me. or Maybe I wont be around.
• Expressions of hopelessness and helplessness
• Previous suicide attempts
• Daring or risk-taking behavior
• Personality changes
• Depression
• Giving away prized possessions
• Lack of interest in future plans

24
What To Do

• Good and thorough assessment.
• Trust your instincts that the person may be in
  trouble
• Talk with the person about your concerns.
  Communication needs to include LISTENING.
• Ask direct questions without being judgmental.
  Determine if the person has a specific plan to
  carry out the suicide. The more detailed the
  plan, the greater the risk.
• Get professional help, even if the person
  resists.
• Do not leave the person alone.
• Do not swear to secrecy.
• Do not act shocked or judgmental.